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Duplex Criteria for Native Artery Superior Mesenteric Artery Stenosis Overestimates Stenosis in Stented Superior Mesenteric Arteries

Erica L. Mitchell¹, Dae Y. Lee¹, Ramya Raman¹, Timothy K. Liem¹, Gregory J. Landry¹, Frederick S. Keller², Gregory L. Moneta.^1
1Oregon Health & Science University, Portland, Ore.;²The Dotter Institute, Portland, Ore.
 
OBJECTIVES: Superior mesenteric artery (SMA) duplex scanning is utilized to screen for high-grade (≥70%) SMA stenosis {peak systolic velocity (PSV) ≥275 cm/s} and for follow-up of SMA bypass grafts and stents. Expected duplex findings in SMA bypass grafts have been recently reported. There is, however, no information correlating duplex scans from stented SMAs to procedural angiograms in patients treated for high grade (≥70%) SMA stenosis. We report validation of duplex criteria for high-grade native artery SMA stenosis, and duplex results after SMA stent placement correlated with angiograms and angiographically measured pressure gradients pre and post SMA stent placement.

METHODS/RESULTS: Thirty four patients with symptoms consistent with chronic mesenteric ischemia were treated with SMA stents. Pre-intervention angiography demonstrated >70% SMA stenosis or SMA occlusion in all patients. Pre-intervention pressure gradients were obtained in 20 stenotic but patent SMAs and averaged 52±37 mmHg, range15 to 187mmHg. Sixteen of the patients had SMA duplex prior to angiography and 15 (94%) demonstrated a SMA PSV ≥75 cm/sec or no flow, (mean 445±160 cm/sec in patent arteries, range 256 to 770cm/s). Post stent placement angiography demonstrated <30% SMA stenosis in all 34 patients. Post stent pressure gradients were obtained in 18 patients and averaged 11±13 mmHg, range 0 to 45mmHg, p=0.00004 compared to pre stent pressure gradients. Early post stent duplex studies were obtained in 11 patients with all 11 (100%) demonstrating PSVs ≥275 cm/s (mean 344±44 cm/s, range 279 to 416 cm/s), p = 0.039 compared to pre stent PSVs.

CONCLUSIONS: SMA stenting provides good anatomic results and significantly reduces measured pressure gradients. Duplex measured SMA PSVs are reduced post stent placement but despite good angiographic results remain above criteria predicting high-grade native artery SMA stenosis. Duplex criteria developed to identify high-grade native artery SMA stenosis accurately predict high-grade native artery SMA stenosis but overestimate stenosis in stented SMAs. New duplex criteria are required to predict high-grade stenosis in stented SMAs

AUTHOR DISCLOSURES: E.L. Mitchell, None; D.Y. Lee, None; R. Raman, None; T.K. Liem, None; G.J. Landry, None; F.S. Keller, None; G.L. Moneta, None.